Colon and Lung cancer

Question 1

Fluorouracil IV only

MOA

FU and 5 FU are the same

Answer 1

Interferes with DNA and RNA Synthesis

• 2 Active metabolites
• FUMP- Incorporate into RNA inhibits cell growth
• FdUMP- Inhibits thymidylate synthetase, depletes thymidine tiphosphate
• DUAL mechanism of action S phase cell death

Question 2

Capecitabine

MOA

Answer 2

Oral version of 5FU

Question 3

5-FU and Capecitabine SEs?

How are they given?

Answer 3

• Mucositis
• Diarrhea
• N/V
• Myelosuppression
• Alopecia
• Hand-foot syndrome (higher with capecitabine blisters on hands and feet)

Question 4

What medication enhances the killing of 5-FU?

What regimens are these not used in?

Answer 4

Leucovorin

• Not used in capecitabine regimens
• NOT CHEMOTHERAPY!!
  Forms complex with FdUMP and thymidylate synthase. DUMP DNA

Question 5

Oxaliplatin MOA?

Answer 5

Platinum agent

Forms/ inner and intra platinum DNA crosslinks

Crossling prevents DNA synth/replication

Oxaliplatin is usually dropped first due to SEs

Question 6

Oxaliplatin SEs

Answer 6

• Cold neuropathy- Acute and chronic. hursts when youtouch cold shit. gloves to get milk
• Hypersensitivity Reactions usually takes like 6-8 cycles before you see it
• Nephrotox
• Ototoxicity

Question 7

Irinotecan

MOA

Active metabolite

Answer 7

Topo 1 inhibitor

prevents re-ligation of single stranded DNA breaks

Damages dsDNA Cytotoxic

Active metabolite SN38 if someone has a mutation that decreases UGT1A1 you can see increased accumulation of this and increased toxicity

Question 8

Irinotecan

AEs?

How to treat?

Answer 8

• Diarrhea
  
  • Early within 24 hours- Atropine
  • Late- over 24 hours loperamide

Question 9

Bevacizumab

MOA?

Answer 9

Binds to/neutralizes vascular endothelial growth factor VEGF

Reduces O2 supply reduces cell growth

Question 10

Bevacizumab

SEs?

Answer 10

Thromboemboli

Or Hemorrhage

CLOTTING OR BLEEDING

Have to hold therapy 4 weeks before and after with any type of surgery because of bleed risk

Question 11

Ramucirumab

Answer 11

Inhibits VEGF2

Question 12

What do you have to give with Ramucirumab prior to infusion?

Answer 12

H1 antagonist IV

Question 13

What are the hallmarks for VEG Fs?

Answer 13

Impaired wound healing

HTN

EDEMA

Thrombosis

Hemmorrage

Proteinuria

Question 14

Ziv-Aflibercept

MOA?

Answer 14

Binds up free VEGF thats floating arounf

Soluble Decoy Receptor

Question 15

Ziv aflibercept SEs?

WHen is it given?

Answer 15

Hemorrage

Impaired wound heal

VTE

Proteinuria

Given in combination with FOLFIRI after failure of Oxaliplatin based Regimen

Question 16

Cetuximab

MOA?

Answer 16

Binds to EGFR

Completely inhibits binding of EGFR and other lugands

Blocks phosphorylation and activation of intracellular tyrosine kinases- this inhibits cell survival, growth, proliferation and transformation

Cells with RAS mutations are uneffected by EGFR inhibition

Question 17

Cetuximab

SEs?

Answer 17

• Hypersensitivity Rxns BBW
• Acneiform Rash (itching as well and its not acne)
• Pruritis
• N,D, Constipation
• Infection
• E+ Disurbances
• Premedication with DIphen, fami, albuterol

Question 18

Panitumumab

MOA

Answer 18

EGFR inhibitor HUMAN

Ancneform rash/pruritis

Pulmonary Toxicity

Question 19

What medications do you need to test for RAS mutation

Answer 19

Pantitumumab

Cetuximab

have to have KRAS wildtype

or just a EGFR mutation

Question 20

Regarafenib

MOA

Answer 20

Multikinase inhibitor

suppression of tumor growth

Question 21

Regorafenib

SEs?

Answer 21

hepatoxicity and Hypertension

Question 22

Regorafenib how do you take it and when is it used?

What Drug interactions?

Answer 22

after failure of multiple regimens

Swallow tablet whole with water

Following a low fat meal <600 calories

CYP3A4

Question 23

Trifluridine and Tipiracil

MOA

Whats the tipiracil for?

SEs?

Answer 23

Super 5-FU

Product binds to thymidylate synthase

DNA strand break formation

Tipiracil is there to prevent the degredation of Trifluridine By inhibiting thymidine phosphorylation

N/V/Diarrhea

Myelosuppression

1 hour after morning and evening meals

Question 24

Pemetrexed

What is it?

What two things need to be given beforeand when?

What should you avoid

Answer 24

Folic Acid 7 days prior to first day of the first cycle

Vitamin B1 7 days prior as well- Give every 3 cycles there after

Dont give NSAIDs during

Question 25

Cisplatin is associated with intense?

Answer 25

Nephrotoxicity

N/V high- delayed emetogenic NK1-Zofran-Cyprexa-Olanzapine

Give Cis and then flush it out because of kidney tox

Question 26

When would you want to use Carb?

How is it dose?

What needles cant you use?

AEs?

Answer 26

Significant less nephrotox and emetogenicity

Calvert Equation for dosing

Total dose= Target AUCx(GFR+25)

AUC goal is 4-6

Bone Marrow Suppression

No aluminum Needles

Question 27

Erlotinib

MOA?

Answer 27

Tyrosine Kinase

Prevents downstream signaling

Dont switch until you see progression or toxicity

Empty stomach 1 hour before 2 hours after

Needs acidic environment no PPIs

Skin Rash and Puritis

Question 28

Afatinib

Answer 28

Absorption decreasd with fat

Acneform rash/puritis

Question 29

Osimertinib

MOA

Answer 29

Irreversuble EGFR inhibitor Binds to select mutations form

Never

Skin rash

Diarrhea

Interstitial Pneumotitis

Question 30

Crizotinib

Until Dx progression or tox

Answer 30

ALK mutation

Visual Disturbances

URTI

Question 31

Ceritinib

Stop when progress or tox

If pt has DM neuropathy?

Answer 31

Neuropathy

SKin rash

Question 32

PDL-1 Mutation

Tx

SEs

What do you treat?

Answer 32

Pembrolizumab

Injections site rxn

and Immune mediated toxicities

Hepatitis, colitits, thyroiditis, pneumotitis, dermatitis

Treat with corticoroids if serious